Provider Demographics
NPI:1457466609
Name:OLSON, TRICIA L (OD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:L
Last Name:OLSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18857 CTY HWY BR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581
Mailing Address - Country:US
Mailing Address - Phone:608-647-9031
Mailing Address - Fax:
Practice Address - Street 1:1850 BOHMANN DR
Practice Address - Street 2:SUITE 11
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2978
Practice Address - Country:US
Practice Address - Phone:608-649-3937
Practice Address - Fax:608-649-3938
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2890-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38623900Medicaid
WI38623900Medicaid
WIU99627Medicare UPIN